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ELEC'~iICAL PERNET APPLICATION <br /> Please oomlY, ete all Sections, 1through5 <br /> <br />1, LOCAlX)N OF If'~TALLAltDN <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, C~E~jon 97301 <br /> <br /> Phone 588-5147 8:00 a.m. - 4:30 p.m. <br /> Code-,~Phane: 588-7g04 SITE #; <br /> FAX: 588-7948 <br /> Dae: <br /> <br />Electrical Contractor <br /> <br />Mailing Address <br />Property Owner <br />Contrecter"s License No,, <br />Contractor's Board Rog. No,, I Job No. <br />Signature of Supervising Eleotrlc[sn <br />Supervlsor"s License No, I Phone No, <br />21&, FOR OWNER INSTALLA'nON~ <br /> <br />Properly Owner -~ j~.~//,~.~ <br /> <br />The Installation Is being made on proper~ I ~n which Is not intended for sa[e,, <br /> <br /> Permit No,, <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br />Number of Inspections ~er ~en~lt eltewed <br /> <br />A. Residential, Stegle or <br />Multi-Family per dwelling unit <br /> <br /> 1500 ~ fL or le~ <br /> <br /> Each M fg,'d H~ et Modul~ <br /> <br /> R~nn~t Only <br /> <br /> 200 a~ er le~ <br /> ~I ~ste <br /> <br /> One ~i~ult <br /> <br /> E~h ~t ~n ~tmui~ or posen <br /> <br /> E~ pu~ <br /> Ea~ s~n or outli~ ligh~ng <br /> Sign~ ~lmuit(s) or a limi~ enemy <br /> <br />~ ~ar <br /> <br />Items x <br /> <br /> 1 <br /> <br />__Sss.__ <br />$35. <br /> <br />__Sss.__ <br />$13o, <br />__$300,,__ <br />$~s <br /> <br />$35. 2 <br /> <br />__$3~. 2 <br /> <br />$36, 2 <br /> <br /> PU~I REVIEW SECnON <br /> Check appropriate item and enter fee in ..~.cEan 5B. <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br />__ System over 600 vdits <br />__ Building over 2 stedes <br /> Building over 10,000 square feet <br />__ Occ~peet load over 300 persons <br />__ Manufactured Dwelling Patk/l:incmat~n Perk <br /> Hazardous Locations <br /> <br />Submit 2 sets of plans wit~ any of the above, <br />TemporeJ'/construction services do not ap~ly. <br /> <br />Al. Enter tetel of fees from Sec. <br />A2, Add5% sumhage (.05xA1) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Inves~ga~oo Fee (if required) <br />D, Reinr~n Fee ($25,00) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />